Cannabis is the third most commonly used substance among adolescents in the United States.36 Potency and societal acceptance are rising, with use increasing further during the COVID-19 pandemic.37 CHS is one serious consequence. When pediatricians are aware, CHS symptoms can be the canary in the coal mine, leading patients to multidisciplinary support, insight, motivation, and long-term recovery. By Rome IV criteria, the diagnosis of CHS is confirmed only when symptoms resolve upon ceasing use. Clinicians should help patients toward this goal following physiologic stabilization. These help quantify the degree of substance use to build insight and direct referrals. Your provider may run blood tests, urinalysis, or imaging scans like CT or MRI to rule out other conditions.

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• It is considered as a variant of cyclical vomiting syndrome seen in cannabis users especially characterized by compulsive hot bathing/showers to relieve the symptoms.
• Our search did not yield any randomized trials assessing the diagnosis, pathophysiology, or treatment of CHS.
• The only surefire way to avoid developing CHS is to not use marijuana.

CHS is unique in presentation, because of the cannabis’s biphasic effect as anti-emetic at low doses and pro-emetic at higher doses, and the association with pathological hot water bathing. In this narrative review, we elaborate on the role of the ECS, its management, and the identification of gaps in our current knowledge of CHS to further enhance its understanding in the future. Cannabis, derived from Cannabis sativa plants, is a prevalent illicit substance in the United States, containing over 400 chemicals, including 100 cannabinoids, each affecting the body’s organs differently upon ingestion. Cannabis hyperemesis syndrome (CHS) is a gut–brain axis disorder characterized by recurring nausea and vomiting intensified by excessive cannabis consumption.

Hyperemetic phase

• Cardiac arrhythmias have not been observed with gradual dose titration.
• The patient may check into a motel or finally come to the hospital when they have exhausted the hot water supply at home.
• Because CHS is a fairly new medical condition, not all doctors know about it.
• The CHS group achieved a 70% improvement, and the CVS group achieved an 80% improvement following the treatment with amitriptyline 5.
• There are many suggested pathophysiologic mechanisms of CHS, though evidence for each is minimal (see Table 3).

If you already suspect you’re at risk, the best move is to cut back or quit cannabis altogether. Marijuana dependency can develop, making it hard to stop, even if you realize it’s hurting your life. Feeling what is alcoholism nauseated also kills your appetite, and it’s easy to become dehydrated.

What Are the Health Complications of CHS?

If you do use cannabis, quitting can ward off future episodes of CHS. Symptoms will usually improve after 1 or 2 days, as long as you don’t use cannabis during this time. Researchers are still trying to figure out exactly what causes CHS in some people who regularly use cannabis but not others.

Of the 88 case reports, 8 were excluded secondary to cannabinoid hyperemesis syndrome inability to access the original text, the report being published in a non-English language or if the case did not ultimately yield a clinical diagnosis of CHS as reported by the authors 108–118. Our search did not yield any randomized trials assessing the diagnosis, pathophysiology, or treatment of CHS. Given that evidence statements are based primarily on case reports and case series, the vast majority of evidence is considered limited.

• Therefore, substance abuse experts should be involved when the diagnosis is made.
• Many people with CHS go to their doctor or an emergency room (ER) for treatment.
• Anandamide is synthesized from the precursor N-arachidonoyl phosphatidylethanolamine, while 2-AG is produced from an inositol-1,2-diacylglycerol precursor 8,16,17.
• It is generally administered at 0.5 to 2 mg intravenously every six hours, as needed 77,78.
• More educational campaigns targeting heavy recreational and medicinal cannabis users can help in recognizing and preventing CHS.
• A systematic review by Richards et al. 64 showed that these standard anti-emetics are often ineffective when used alone and demonstrated superior efficacy with intravenous benzodiazepines.

Compulsive bathing or showering in hot water to soothe nausea is also a hallmark sign of CHS. Understanding the ECS and its effects on the vomiting center of the brain are fundamental to explain the effect of cannabis for this biphasic response 21. The ECS is composed of ligands, receptors, signaling, and enzymes (its regulators and inhibitors) 22. By quitting marijuana and sticking to a well-structured program, you can free yourself from the revolving door of nausea, vomiting, and hospital visits that CHS often brings. Recovery doesn’t happen overnight, but with consistent effort, you’ll likely see your symptoms ease. Over time, your body can heal, your energy can return, and you can rebuild daily routines that promote wellness.

What causes cannabinoid hyperemesis syndrome?

• The almost pathognomic aspect of a patient’s presenting history is that their symptoms are relieved by hot baths or shower.
• While many providers utilize these agents in practice and find them effective, prospective case-control studies are needed before recommendations can be made based upon effectiveness.
• One study found that 32.9% of self-reported frequent marijuana users who came to an emergency department for care met the criteria for CHS.
• If you have cannabis use disorder and need help quitting, professional treatment is available.
• Changes in the endocannabinoid system may lead to alterations in other systems that have the potential to promote nausea and vomiting.
• In the brain, CB1 receptors are localized to the cerebral cortex, hypothalamus, anterior cingulate gyrus, hippocampus, cerebellum, and basal ganglia 8.

It is often described as a syndrome that affects only a small portion of people who are heavy, chronic cannabis users. However, research suggests that it could be far more prevalent and may continue to increase due to factors like the legalization of marijuana and the increased use of medical marijuana. A 26-year-old Caucasian male presented to our center with a 1-week history of severe colicky epigastric pain heralded by significant nausea for 3 weeks. He had approximately 20 episodes of bilious vomiting daily with numerous bouts of retching.

These compounds are referred to as endogenous cannabinoids, or endocannabinoids. The best characterized endocannabinoids are anandamide and 2-arachidonylglycerol (2-AG) https://ecosoberhouse.com/ 9. The endocannabinoids are present in both the central nervous system 8 and enteric nervous system 15. Anandamide and 2-AG are released locally on demand by neurons, are present in small quantities, and undergo rapid inactivation 8. Endocannabinoids are thought to act as either neuromodulators or neurotransmitters 11. Anandamide and 2-AG possess similar biochemical structures, but each has a distinct pathway for biosynthesis and degradation.